Psychological Bulletin 1996, Vol. 119, No. 3,448-487 Copyright 1996 by the American Psychological Association, Inc. 0033-2909/96/S3.00 Empirical Research on Religion and Psychotherapeutic Processes and Outcomes: A 10-Year Review and Research Prospectus Everett L. Worthington, Jr., and Tarq A. Kurusu Virginia Commonwealth University Michael E. McCullough Louisiana Tech University Steven J. Sandage Virginia Commonwealth University A decade of research on religion and counseling, consisting of 148 empirical articles, was reviewed. Methodological sophistication, poor a decade ago, has approached current secular standards, except in outcome research. Religious people cannot be assumed to be mentally unhealthy. Nonreligious and religious counselors share most counseling-relevant values but differ in the value they place on religion. Those religious differences affect clinical judgment and behavior, especially with religious clients. Religious interventions have been techniques imported from formal religious traditions and used as adjuncts to counseling or traditional theories of counseling adapted to religious clients. The authors suggest a research agenda and speculate about future mental health practices. With the virtual acceptance of multiculturalism as a "fourth force" in psychology (Cheatham, Ivey, Ivey, & Simek-Morgan, 1993), the role of religion in counseling and psychotherapy has become an acceptable topic for debate and discussion and has be- come an acceptable aspect of training. 1 Religious experience is not only part of multiculturalism but also consistent with the overall direction of postmodern culture. The acceptance of some role of religion in counseling has thus exploded into the mainstream of counseling and clinical psychology over the last decade. In 1986, Worthington reviewed a decade (1974-early 1984) of empirical research on the role of religion in counseling, updating a review by Arnold and Schick (1979). Since 1986, interest in religion and counseling has boomed. Professional organizations have sprouted. One example is the American Association of Christian Counselors, which has grown from 2,000 to over 16,000 members between 1993 and early 1995. Many other pro- fessional associations have thrived (i.e., the Christian Association for Psychological Studies, Society for the Scientific Study of Reli- gion, Religious Research Association, the Christian Medical and Dental Society, etc.). Conferences and workshops have been in high demand. For example, at the American Psychological Asso- ciation's annual conventions, attendance at preconvention work- shops and regular sessions concerning religion has been high in recent years. Religiously oriented doctoral training programs in clinical psychology have produced substantial numbers of reli- Everett L. Worthington, Jr., Taro A. Kurusu, and Steven J. Sandage, Department of Psychology, Virginia Commonwealth University; Mi- chael E. McCullough, Department of Psychology, Louisiana Tech University. Correspondence concerning this article should be addressed to Ever- ett L. Worthington, Jr., Department of Psychology, Virginia Common- wealth University, Thurston House, 808 West Franklin Street, P. O. Box 842018, Richmond, Virginia 23284-2018. Electronic mail may be sent via Internet toeworth@vcu.edu. gious therapists, who see religious as well as nonreligious clients. Pressures created in part by managed mental health care initia- tives have led to making religious counseling centers into large entities that employ hosts of religious counselors and see many religious clients. As a consequence of the growing interest in reli- gion and counseling, a plethora of theoretical, polemic, and con- ceptual works have been published. These include (among others) a recent appeal for rapprochement between science and religion by Jones (1994) in the American Psychologist; reviews of religion and mental health by Bergin in the American Psychol- ogist Integration (Bergin, 1991), the Journal of Psychotherapy Integration (Payne, Bergin, & Loftus, 1992), and Counseling and Values (Bergin, 1985); reviews by Gorsuch of the psychology of religion in the Annual Review of Psychology (1988) and of mea- surement in religion in the American Psychologist (1984); con- ceptual, theoretical, and review articles by Worthington in the Journal of Counseling Psychology (1988), The Counseling Psy- chologist (1989), and the Journal of Psychology and Christianity (1991b); and a meta-analysis of intrinsic and extrinsic religion and mental health in the Journal of Personality and Social Psy- chology (Donahue, 1985). Some special issues of journals have addressed religious counseling (Sorenson, 1994; Watson, 1994; Worthington, 199la, 1994). Additionally, major volumes have reported research on religious counseling (e.g., Benner, 1987a, 1987b; Burke &Miranti, 1995; Jones &Butman, 1991;Lovinger, 1990; Miller & Jackson, 1995; Miller & Martin, 1988; Stern, 1985a; Worthington, 1993). Empirical research on the role of religion in counseling has increased considerably. As one index of this growth, the number of journals reviewed for the present article was 36, whereas Worthington reviewed only 22 in 1986. This amazing growth in interest in religious counseling 1 Throughout this article, the term counseling is used generically to refer to counseling, psychotherapy, or both. Similarly, counselors can refer to counselors, psychotherapists, or both. 448